{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AESLEHCENOOB M ","gend":1,"add":"RAC 322RD LLOR","city":"FRIES","state":"VA","zip":"24330-9998","dob":"1993-01-03","age":"","mstatus":"","insh":"5575110*00","cliId":"","pno":"32\/6726616-7","cno":"","email":"","ename":"","eno":"","pphy":"FANT, VANESSA S MD","ppno":"276\/601-2841","pcpadd":"813 W STUART DR","pcpcity":"GALAX","pcpstate":"VA","pcpzip":24333,"pcpcounty":"","pcpid":"","pcpname":"FIRST CHOICE HEALTH CARE LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","J02.0","R11.2","J01.90","M54.42","S39.012A","M46.1","J45.901","Z20.828","M79.631","M25.531","J30.89","J45.40","F41.1","NO DATA","F31.9","F60.3","J45.21","J11.1"],"date":["2021-11-19","2021-04-15","2021-04-15","2021-11-21","2020-11-03","2020-11-13","2020-11-13","2021-06-01","2021-03-08","2021-04-21","2021-04-21","2021-06-07","2021-06-07","2022-06-09","2022-06-09","2022-06-09","2022-06-09","2022-06-09","2022-11-21"],"priorHcc":["","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","BUSPIRONE","TAB 5MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00904685289","LORATADINE","TAB 10MG","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","VENLAFAXINE","CAP 150MG ER","","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","16571030216","GUAIFENESIN","SYP 100-10\/5","50","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","10","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","00186091612","PULMICORT","INH 180MCG","1","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}